Aerodynamic characteristics inside the rhino-sinonasal cavity after functional endoscopic sinus surgery

The aim of this study was to evaluate effects of functional endoscopic sinus surgery (FESS) on transient nasal aerodynamic flow patterns using computational fluid dynamics (CFD) simulations.

A three-dimensional model of the nasal cavity was constructed from CT scans of a patient with FESS interventions on the right side of the nasal cavity. CFD simulations were then performed for unsteady aerodynamic flow modeling inside the nasal cavity as well as the sinuses.

Comparisons of the local velocity magnitude and streamline distributions inside the left and right nasal cavity and maxillary sinus regions were presented. Because of the FESS procedures in the right nasal cavity, existences and distributions of local circulations (vortexes) were found to be significantly different for the same nasal airflow rate but at different acceleration, deceleration, or quiet phases in the maxillary sinus region on the FESS side. Because of inertia effects, local internal airflow with circulation existences was continuous throughout the whole respiration cycle. With a larger peak inspiration flow rate, the airflow intensity inside the enlarged maxillary sinus increased significantly. Possible outcomes on functional performances of the nose were also examined and discussed.

Surgical enlargements of natural ostium of the maxillary sinus will change the aerodynamic patterns inside the main nasal cavity and maxillary sinus regions, which may affect normal nasal physiological functions. Local inertia effects play more important roles for the internal nasal airflow pattern changes and thus such conventional FESS procedures should be carefully planned.